Clinical Significance of Neoadjuvant Chemotherapy With Gemcitabine Plus S-1 for Resectable Pancreatic Ductal Adenocarcinoma

Abstract

Background/Aim: Little is known about the efficacy of neoadjuvant chemotherapy (NAC) with gemcitabine plus S-1 (GS) for patients with resectable pancreatic ductal adenocarcinoma (R-PDAC). The aim of this study was to investigate differences in the long-term outcome of patients with R-PDAC undergoing pancreatectomy with and without NAC-GS to clarify the clinical significance of NAC-GS. Patients and Methods: A total of 77 patients with R-PDAC who were scheduled for pancreatectomy between January 2012 and December 2017 were enrolled. Of these patients, 39 received NAC-GS (GS group) and 38 had upfront surgery (UFS group). Results: Among the 77 patients, one patient in each group did not undergo pancreatectomy due to intraoperative non-curative factors. Median tumor size and the number of lymph nodes with metastasis were significantly lower in the GS group than in the UFS group (p=0.002 and p=0.017). However, the 5-year overall survival rate was similar in the two groups (26.1% versus 21.5%, p=0.930). Conclusion: NAC-GS may not be recommended for patients with R-PDAC since it does not seem to offer any survival benefits.

Comparison of plastic stent versus metal stent in preoperative biliary drainage for pancreatic head cancer with neoadjuvant chemoradiotherapy

“…The preoperative waiting period has been reported to be 42-124 days. 5,6,19,22,23 In the present study, the median preoperative waiting period was 73 days in the PS group and 79 days in the MS group, which was not different from those of previous reports. The occurrence of severe obstructive jaundice and cholangitis resulted in interruption of NAC(R)T, which consequently led to longer waiting periods.…”

Effect and limitation of neoadjuvant chemotherapy for pancreatic ductal adenocarcinoma: consideration from a new perspective

“…The breakdown of NAC regimen is as follows: gemcitabine in two patients, GS in 62 patients, GnP in two patients, and GnP following GS in one patient. Thus, 92.5% of NAC is the two cycles of GS regimen, the detail of which is described elsewhere [ 17 ]. Cycles of other NAC regimen was flexibly determined in accordance with the patient’s general condition.…”

“…In this study, 92.5% of NAC were the GS regimen. Suzuki et al, a research group directed by Kubota who is also a member of this research group, reported that radiographic response to the GS therapy was 15.4% of partial response and 84.6% of stable disease in primary resectable PDAC [ 17 ]. All GS group ( n = 38) and 27 of the UFS group ( n = 37) in their prospective randomized control study are also included in this study subjects.…”

“…We cannot know the true pathologic stage of PDAC before NAC without exploratory laparotomy. Assuming that GS-mediated downstaging from stage III/IV to stage I/II occurred in 20% of the original stage III/IV patients in the GS group based on the previous study [ 17 ], it is calculated that original stage I/II and III/IV patients were 57 and 5, respectively. This suggests that almost all GS group with pathologic stages I/II at surgery (57 of 58: 98.3%) might have been originally pathologic stages I/II before starting GS.…”

Neoadjuvant therapy for resectable pancreatic cancer: a narrative review

“…Although the pathological outcome was better, no survival benefit was seen in NAT patients; in fact, Barbier et al [30] found long-term survival was slightly better in the surgery-first group. [58] Suzuki et al [26] did not recommend GS NAT, and Kurata et al [27] recommended that NAT may be applied to borderline resectable and locally advanced PDAC to enable surgical resection, but upfront surgery was desirable for primary resectable PDAC. No difference in the mOS was observed in the Palmer et al [23] study either.…”